Systems that link time-stamped images in a video stream to a dictation of a review of the images

ABSTRACT

Systems are provided that link images in a video stream to a dictation of a review of the images. The dictation can follow a systematic analysis script which can include script pathways that depend on a prior response to the systematic analysis script. The systems include a navigation engine for a parsing of image data for reconstructing discrete images into independently viewable subsets of discrete images that are custom-designed for the video stream, the parsing using criteria that includes body part; and, case details that include age, sex, ethnicity, disease, genomic markers, and other correlating diagnostics; and, an indexing module for locating and retrieving a set of indexed images by the body part and the case details, wherein, the indexing of each image by the body part and the case details provides a linking mechanism for the point-and-click-free viewing of the set of indexed images.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.18/115,651, filed Feb. 28, 2023, which is a continuation of U.S.application Ser. No. 16/872,996, filed May 12, 2020, now U.S. Pat. No.11,625,146, issued Apr. 11, 2023, which is a continuation of U.S.application Ser. No. 16/230,871, filed Dec. 21, 2018, now U.S. Pat. No.10,691,306, issued Jun. 23, 2020, which is a continuation of U.S.application Ser. No. 15/614,143, filed Jun. 5, 2017, now U.S. Pat. No.10,198,151, issued Feb. 5, 2019, which is a continuation of U.S.application Ser. No. 14/588,300, filed Dec. 31, 2014, now U.S. Pat. No.9,703,451, issued Jul. 11, 2017, which is a continuation of U.S.application Ser. No. 14/083,416, filed Nov. 18, 2013, now U.S. Pat. No.8,954,884, issued Feb. 10, 2015, each of which is hereby incorporatedherein by reference in it's entirety.

BACKGROUND Field of the Invention

The teachings generally relate to a navigation system for viewing of animage data stack in less time with less effort and less repetitivemotions, such as a data stack of medical images.

Description of the Related Art

Radiologists use cutting-edge imaging technology to examine organs andtissues to diagnose injuries and illnesses so treatment can begin. Whileearly radiologists had only film X-rays to work with, modernradiologists have many imaging tools at their disposal including, butnot limited to, X-ray radiography, ultrasound, computerized tomography(CT), magnetic resonance imaging (MRI), positron emission tomography(PET), and nuclear imaging. Advances in digital technology now allow foreasy transmission of image data in the practice of “telemedicine,” suchthat modern radiologists can practice in any location having internetconnectivity. This is valuable to society, as telemedicine providesskilled, emergency consultations and collaborations after hours andaround the globe. In the course of providing such services, problemsarise. For example, the modern radiologist is often forced to go forlong spans of time working at a rather traditional computer workstation,faced with the burden of efficiently analyzing images and deliveringdiagnoses using traditional computer workstation tools.

The problem is exacerbated in that advances in digital imaging have madeit easy to rapidly produce and deliver numerous medical images to aradiologist, more than ever before. For example, a data-stack may havejust contained axial images 20 years ago or so, whereas now thedata-stack may be reconstructed in multiple imaging planes, multiplereconstruction algorithms, or three-dimensional models. As a result, 20years ago or so, a radiologist may have averaged 20-30 images per case,whereas now, the radiologist may potentially be presented with upwardsof 2000-3000 images. The radiologist's mechanical ability becomes theslow-step, resulting in slower and strenuous working conditions to sort,select, view, and interpret the increasing amounts of image data usingtraditional computer workstation tools that still include thepoint-and-click mouse as a navigation device. As such, the currentnavigation device limitations hinder the radiologist's ability to meetthe demands of the job, which include providing uniform and reproducibleanalyses of large data-stacks, as rapidly and accurately as possible,for use worldwide.

These problems associated with handling and viewing the data-stacks hasbeen addressed through systems that can format, store, and distributethe data in a universal manner. Storage and access to the variousformats of the image data (imaging modalities) has been advanced throughthe use of picture archiving and communication systems (PACS), allowingimages and reports to be transmitted digitally, eliminating the need tomanually file, retrieve, or transport film jackets by offering auniversal format for image storage and transfer. PACS consists of fourmajor components: (i) imaging modalities such as X-ray plain film,computed tomography, and magnetic resonance imaging; (ii) a securednetwork for the transmission of confidential patient information; (iii)workstations for interpreting and reviewing images; and, (iv) a databasefor the storage and retrieval of images and reports. PACS has helped tobreak-down physical and time barriers associated with traditionalfilm-based image retrieval, distribution, and display, but it has donenothing to address the inefficiencies of the radiologist's workstation.Currently, for example, the radiologist viewing thousands of imagesdaily uses a computer system that is very much like a system used by theordinary computer user that is not under anywhere near the sameproduction expectations and time constraints. Both the radiologist andordinary user will have a system that simply includes a processor, adatabase for receiving and storing images, a graphical user interfacefor viewing the images, and most importantly, the traditionalpoint-and-click mouse for pointing-to, and selecting, the image data forviewing and interpreting images by group, subgroup, or individually.

Identifiable problems associated with the inefficiencies of thetraditional radiologist workstation include (i) the time it takes toreview a case; (ii) the ability of the radiologist to focus on theimages themselves as opposed to the extra effort currently required forsorting, navigating, and selecting images; and (iii) the repetitivestress injuries that have become an expected occupational hazard to theradiologist. Reducing the time it takes to deliver an interpretation,and improving the ability to focus on making the interpretation benefitsall. And, reducing the use of the traditional “point-and-click” stepsinherent to the standard “mouse” control will help remove redundanciesand inefficiencies at the radiologist's workstation, resulting inreduction in repetitive stress injuries in the modern radiologist. Inone study of repetitive stress injuries in radiologists working in aPACS-based radiology department, for example, a total of 73 responseswere received (a 68% response rate from the department). See, forexample, Boiselle, P. M. J Am Coll Radiol. 5(8):919-23 (2008). Mostreported working more than 8 hours per day at a personal computer orPACS monitor, and repetitive stress symptoms were reported by 58% ofrespondents, with prior related diagnoses of repetitive stress syndromereported at 38%. See Id. at Abstract.

The teachings provided herein improve the radiologist's workstation toovercome the human limitations associated with the traditional methodsof navigating the “data stack” of the images. One of skill willappreciate a modern workstation that (i) reduces the time it takes toreview a case; (ii) improves the ability of the radiologist to focusmore on the act of interpreting the data rather than navigating thedata; and (iii) reduces the occurrence of repetitive stress injuries dueto multiple movements currently required in the actions of sorting,navigating, selecting, viewing, and interpreting data from the images asgroups, subgroups, or individual images.

SUMMARY

Image analysis systems components, devices, and methods are provided,having image navigation system for example, for rapid, efficient viewingof an image data stack. In fact, systems, components, devices, andmethods are configured to provide an improved use of time and repetitivemotions in the viewing of the data-stack of images, using a navigationsystem for viewing of an image data stack in less time with less effortand less repetitive motions. The navigation device, for example, caninclude: (i) an indexing state selector for selecting an independentlyviewable subset within the image data stack, the desired subset indexedfor an efficient image selection with a single click, or other singlemanipulation, of the indexing state selector; and, (ii) a scrollingstate selector for scrolling through the desired subset as a data seriesof the discrete images. And, a graphical user interface can be operablyconnected to the processor for viewing the plurality of sets of discretesets of images. The systems, components, devices, and methods providedare solutions to the problem of providing rapid, efficient process forviewing a data-stack of images by implementing, for example,“point-free” steps and less repetitive motions.

The teachings generally relate to a navigation system for viewing of animage data stack in less time with less effort and less repetitivemotions, such as a data stack of medical images. It should beappreciated that the navigation devices used in the systems, components,devices, and methods taught herein are configured for an improvedefficiency in the use of time and movements in the viewing of thedata-stack of images. The navigation device, for example, can include:(i) an indexing state selector for independently selecting a desiredsubset within the independently viewable subsets, the desired subsetindexed for the efficient selection with a single click, or other singlemanipulation, of the state selector; and, (ii) a scrolling stateselector for scrolling through the desired subset as a data series ofthe discrete images. And, as with a traditional computer system, one ormore graphical user interfaces can be operably connected to theprocessor, for example, for viewing the plurality of sets of discretesets of images. The systems, components, devices, and methods taughtherein allow for an improved process of viewing a data-stack of imagesby implementing “point-free” steps and less repetitive motions.

The systems can comprise a processor; a database operably connected tothe processor and on a non-transitory computer readable storage mediumfor storing data that is viewed by a user as a plurality of sets ofdiscrete images; a navigation engine operably connected to the processorand on a non-transitory computer readable storage medium for parsing theplurality of sets of discrete images into independently viewable subsetsof the discrete images; an indexing module operably connected to theprocessor and on a non-transitory computer readable storage medium forpoint-free indexing of each of the independently viewable subsets of thediscrete images for an independent selection of each of theindependently viewable subsets of the discrete images; a scrollingmodule operably connected to the processor and on a non-transitorycomputer readable storage medium for assembling each of theindependently viewable subsets of the discrete images as a data seriesof the discrete images, the scrolling module providing for the reviewingby scrolling through the desired subset as the data series of thediscrete images; a navigation device operably connected to thenavigation engine for efficiently viewing the data-stack, for example,by efficiently selecting and viewing each of the independently viewablesubsets of the discrete images.

In addition to accessing images quickly and efficiently for ease ofreview, the system can also be adapted to include the ability to modifyimages, enhance images, combine images, average images, subtract oneimage from another, change image format, and the like. As such, thesystems can further comprise a transformation module operably connectedto the processor and on a non-transitory computer readable storagemedium for transforming the image data into a modified set of images bythe user.

Likewise, the user can have the ability to select images from within adata-stack using, for example, subjective user selection, one or moresoftware communication links, image filtering algorithms or other knownmethodologies, default image criteria, and the like, providing for aselection of subsets of images from the data-stack. As such, the systemcan further parse the images into a preferred subset of imagesselectable by the user. Although this functionality can be provided byany of the engines or modules taught herein, or can be built into adedicated parsing module, in some embodiments, the transformation moduleis configured to provide this parsing function. Likewise, the system caninclude a parsing function that includes image enhancement. As such, thetransformation module can be configured to alter the preferred subset ofimages through image enhancement as a step in the parsing.

One of skill will also appreciate the value in communicating with asecond user or group of users. For example, the second user can be asecond physician or other professional that can assist in the analysisor interpretation of a medical image or medical image data-stack. Assuch, the system can further comprise a data exchange module for sendingor receiving data with a second user, or a group of users, wherein thenavigation device can include a state selector that controls the sendingor receiving with the second user or group of users.

One of skill will appreciate that the efficiency in indexing andscrolling through a data-stack can result in scrolling too fast andoverlooking image data. As such, the teachings provided herein includesystems and methods that incorporate use of a dwell module for governingthe speed at which a user can scroll through images in a data-stack.Moreover, the dwell module can be configured to further control theacceleration of the scrolling.

One of skill will also appreciate that inclusion of video streams ofmedical data can be valuable, for example, in the diagnoses orunderstanding of a disease. As such, the image enhancement provided bythe systems herein can include the storage, display, and/or creation ofa video stream using a preferred subset of images. The navigation ofimages by the scroll module can include the manipulation of a videostream. For example, the systems and methods taught herein can include avideo engine for producing and/or displaying a video stream, and/or thenavigation of a video stream of images in the data-stack. The videoengine can include a frame grabber, in some embodiments, to grab aselect image from the video stream.

One of skill will also appreciate that an analysis of the images in thedata-stack can be facilitated through linking specific image reviewsteps with dictation as the images are reviewed. As such, the systemsand methods taught herein can include a dictation module for prompting,receiving, and/or otherwise processing the data-stack based on criteriaobtained, for example, from a dictation template. The analysis by theuser can, for example, be input through voice and/or text.

One of skill will also appreciate that an analysis of the images in thedata-stack can be facilitated through a systematic analysis that can beeither a default systematic analysis script, or a customized systematicanalysis script, either of which can have script “pathways” that arefollowed by the system in a manner depending on the user's priorresponse or responses. In some embodiments, the user can be prompted byeither a default, or custom, analysis script as the images are reviewed.As such, the systems and methods taught herein can include an analysismodule for prompting automatically, or upon request, a scripted analysisformat for the analysis of one or more images by the user. For example,the dictation module can link one or more series of images in the datastack to a default checklist of queries selected from a group consistingof queries based on imaging technology, a disorder or disease state,region of the body, a standard of care, or a combination thereof. And,in some embodiments, the dictation module can link one or more series ofimages in the data stack to a custom checklist of queries selected froma group consisting of queries based on a physician's preference, apractice group's preference, a particular patient, variations in adisorder or disease state, a set of symptoms, or a combination thereof.

The “point-free” steps and less repetitive motions provide the user withmethods that are much improved over state-of-the-art methods. In someembodiments, the methods include a rapid, efficient viewing of adata-stack through a graphical user interface which can comprise storinga data-stack on a database that is operably connected to a processor,the database on a non-transitory computer readable storage medium forstoring the data that is viewed by a user as a plurality of sets ofdiscrete images; parsing the plurality of sets of discrete images intoindependently viewable subsets of the discrete images with a navigationengine operably connected to the processor and on a non-transitorycomputer readable storage medium; indexing each of the independentlyviewable subsets of the discrete images for an independent selection ofeach of the independently viewable subsets of the discrete images withan indexing module operably connected to the processor and on anon-transitory computer readable storage medium to enable a point-freeindexing of the subsets of the discrete images; assembling each of theindependently viewable subsets of the discrete images as a data seriesof the discrete images for scrolling through the data series with ascrolling module operably connected to the processor and on anon-transitory computer readable storage medium; and, point-freeselecting of each of the independently viewable subsets of the discreteimages with a navigation device operably connected to the navigationengine. The point-free selecting can include, for example, (i)independently selecting a desired subset within the independentlyviewable subsets with an indexing state selector, the desired subsetindexed for an efficient selection with a point-free, activation of thestate selector; and, (ii) scrolling through the desired subset as a dataseries of the discrete images with a scrolling state selector. Theviewing of the images in the data-stack can be accomplished using agraphical user interface operably connected to the processor, followingwhich, the completing of the viewing allows the user to provide ananalysis of the images in the data-stack.

One of skill will appreciate the increased efficiency provided by thesystems, components, devices, and methods taught herein when compared tothe current, state-of-the-art practices. For example, in someembodiments, the selecting results in completing the viewing of thedata-stack in a total viewing time that is at least 10% faster than asecond method using a mouse with a selection button and a scroll wheelto repetitively (i) point-and-click to select each of the independentlyviewable subsets on the graphical user interface, (ii) scroll throughthe desired subset, and (iii) point-and-click to select, both methodshaving an accuracy that is the same, or at least substantially the same.

The teachings provided herein use the medical field as a forum fordiscussing the benefits of the systems and methods presented. It shouldbe appreciated that an image data-stack of any type can be viewed usingthe teachings provided herein. In some embodiments, the medical imagedata includes radiographs. In some embodiments, the medical image dataincludes magnetic resonance imaging. In some embodiments, the medicalimage data includes sonographs, CT images, or PET images. As such, theteachings include a system for a rapid, efficient viewing of adata-stack of medical images through a graphical user interface. Suchsystems can comprise a processor; a database operably connected to theprocessor and on a non-transitory computer readable storage medium forstoring medical image data that is viewed by a user as a plurality ofsets of discrete images; a navigation engine operably connected to theprocessor and on a non-transitory computer readable storage medium forparsing the plurality of sets of discrete images into independentlyviewable subsets of the discrete images; an indexing module operablyconnected to the processor and on a non-transitory computer readablestorage medium for indexing each of the independently viewable subsetsof the discrete images for an independent selection of each of theindependently viewable subsets of the discrete images; a scrollingmodule operably connected to the processor and on a non-transitorycomputer readable storage medium for assembling each of theindependently viewable subsets of the discrete images as a data seriesof the discrete images for scrolling through the desired subset as thedata series of the discrete images; and, a navigation device operablyconnected to the navigation engine for efficiently selecting and viewingeach of the independently viewable subsets of the discrete images.

To facilitate an independent selection and mapping of discrete imagesfor a highly efficient viewing and retrieval, the method can includegiving each image it's own identification means that is linked toprovide a “linking mechanism” between the navigation device and thesets, subsets, and discrete images to allow for the rapid, efficientindexing between the user and images. In some embodiments, the means foridentifying a discrete image, or set of images, can include anyparameter that can be used to assist in parsing or otherwise filter theimages. In some embodiments, the parsing or filtering can beaccomplished using any of a variety of criteria, such as image locationon the screen, image type, such as imaging technology; body part orobject imaged, including position of the image within the body part orobject, time imaged, and the like; and, the subject imaged, perhapsincluding details regarding the subject imaged such as name, age, sex,ethnicity, disease, genomic markers, other correlating diagnostics, andthe like. As such, the indexing step can include furtherindexing/identifying each of the discrete images for independentselection of each of the discrete images as a single image or acustom-designed set of images. In some embodiments, the images areprovided with a systematic, or random, alphanumeric identifier, barcode, or other known means of identification. In some embodiments, theidentifier provides a sufficient number of permutations or variabilityamong each image such that each image will have a unique identifieramong all images. In some embodiments, each image or image subset isunique to all images in the image database for 1 month, 6 months, 1year, 2 years, 5 years, 10 years, 20 years, 50 years, 100 years, or forall time. In some embodiments, the image data base can be a master imagestorage database accessible through downstream computing systems over acomputer network such as an intranet or internet. As such, the indexingstate selector can be adapted to provide a rapid, efficient one-clickindexing to sets, subsets, and discrete images, along with a scrollingstate selector for scrolling through the sets and subsets to thediscrete images, resulting in less repetitive motions by the user.

In some embodiments, the navigation device includes a scrolling platterand a series of one-click buttons corresponding to particular locationsin a data-stack. In some embodiments, the navigation device includes aplurality of scrolling platters, each of which can be set to correspondto a particular set or subset of discrete images, and a plurality ofseries of one-click buttons, each corresponding to particular locationsin the data-stack, the locations of which can be previously specified bythe user. As such, in some embodiments, the navigation device includes afirst scrolling platter and a first series of one-click buttons thatcorrespond to a first graphical user interface; and, a second scrollingplatter and a second series of one-click buttons that correspond to asecond graphical user interface.

One of skill will appreciate that the use of repetitive point-and-clickmotions are laborious, and that the teachings set-forth herein provideimproved efficiencies through at least the direct selection of sets,subsets, and discrete images, resulting in lower repetitions ofmovements and, namely, the elimination of the need to point-and-click onthe graphical user interface. Situations in which the user is frequentlyswitching between two or more data-stacks can be of particular use, forexample, as the ability of the scrolling selector, or plurality ofscrolling selectors, to retain an association with a particular imagesubset can be of great importance to reduce the number of repetitivemotions required to review the images.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows a general technology platform for a system or method taughtherein, according to some embodiments.

FIGS. 2A and 2B illustrate processor-memory diagrams to describecomponents of the system, according to some embodiments.

FIG. 3 is a concept diagram illustrating the system, according to someembodiments.

FIG. 4 illustrates a method for a rapid, efficient viewing of adata-stack through a graphical user interface, according to someembodiments.

FIG. 5 illustrates a prior art navigation device used in viewing adata-stack of images, the device being a mouse with a selection buttonand a scroll wheel.

FIGS. 6A-6D illustrate a “point-and-click-free” process of viewingimages in a data-stack from the perspective of a user of the systemstaught herein, according to some embodiments.

FIG. 7 provides a flowchart illustrating the slower, more complex priorart point-and-click method of viewing a data-stack of images, accordingto some embodiments.

FIG. 8 illustrates a system including a bilateral, direct-selectionnavigation device, according to some embodiments.

FIG. 9 illustrates the dynamics of using a system including a bilateral,direct-selection navigation device, according to some embodiments.

FIG. 10 illustrates a system having bilateral monitors, where at leastone monitor has a plurality of scrolling state selectors and linkingstate selectors, according to some embodiments.

FIG. 11 illustrates a system having three monitors, each monitor havingit's own respective platter and linking mechanism, according to someembodiments.

FIG. 12 illustrates a system having “n” monitors, each monitor havingit's own respective platter and linking mechanism, according to someembodiments.

FIG. 13 illustrates various embodiments of the indexing state selector,according to some embodiments.

FIG. 14 illustrates various embodiments of the scrolling state selector,according to some embodiments.

FIG. 15 shows how a network may be used for the system, according tosome embodiments.

DETAILED DESCRIPTION

A navigation system is provided for rapid, efficient viewing of an imagedata stack through a graphical user interface, such as a data stack ofmedical images, the navigation system adapted for viewing the image datastack in less time with less effort and less repetitive motions. Itshould be appreciated that the navigation devices used in the systems,components, devices, and methods taught herein are configured for animproved efficiency in the use of time and repetitive movements in theviewing of the data-stack of images. The navigation device, for example,can include: (i) an indexing state selector for independently selectinga desired subset within the independently viewable subsets, the desiredsubset indexed for the efficient selection with a single click, or othersingle manipulation, of the state selector; and, (ii) a scrolling stateselector for scrolling through the desired subset as a data series ofthe discrete images. And, a graphical user interface can be operablyconnected to the processor for viewing the plurality of sets of discretesets of images. The systems, components, devices, and methods providedherein are solutions to providing rapid, efficient process for viewing adata-stack of images by implementing, for example, “point-free” stepsand less repetitive motions.

FIG. 1 shows a general technology platform for a system or method taughtherein, according to some embodiments. The computer system 100 may be aconventional computer system and includes a computer 105, I/O devices150, and a display device 155. The computer 105 can include a processor120, a communications interface 125, memory 130, display controller 135,non-volatile storage 140, and I/O controller 145. The computer system100 may be coupled to or include the I/O devices 150 and display device155.

The computer 105 interfaces to external systems through thecommunications interface 125, which may include a modem or networkinterface. It will be appreciated that the communications interface 125can be considered to be part of the computer system 100 or a part of thecomputer 105. The communications interface 125 can be an analog modem,isdn modem, cable modem, token ring interface, satellite transmissioninterface (e.g. “direct PC”), or other interfaces for coupling thecomputer system 100 to other computer systems. In a cellular telephone,or other device receiving information in the same or similar manner,this interface is typically a radio interface for communication with acellular network and may also include some form of cabled interface foruse with an immediately available personal computer. A two-way pagerprovides an example in which the communications interface 125 istypically a radio interface for communication with a data transmissionnetwork but may similarly include a cabled or cradled interface as well.In a personal digital assistant, the communications interface 125typically includes a cradled or cabled interface and may also includesome form of radio interface, such as a BLUETOOTH or 802.11 interface,or a cellular radio interface, for example.

The processor 120 may be, for example, any suitable processor, such as aconventional microprocessor including, but not limited to, an IntelPentium microprocessor or Motorola power PC microprocessor, a TexasInstruments digital signal processor, or a combination of suchcomponents. The memory 130 is coupled to the processor 120 by a bus. Thememory 130 can be dynamic random access memory (DRAM) and can alsoinclude static ram (SRAM). The bus couples the processor 120 to thememory 130, also to the non-volatile storage 140, to the displaycontroller 135, and to the I/O controller 145.

The I/O devices 150 can include a keyboard, disk drives, printers, ascanner, and other input and output devices, including a mouse or otherpointing device. And, the teachings provided here include a navigationdevice having an indexing state selector and a scrolling state selector.The display controller 135 may control in the conventional manner adisplay on the display device 155, which can be, for example, a cathoderay tube (CRT) or liquid crystal display (LCD), or perhaps alight-emitting-diode display (LED). The display controller 135 and theI/O controller 145 can be implemented with conventional well knowntechnology, meaning that they may be integrated together, for example.

The non-volatile storage 140 is often a FLASH memory or read-onlymemory, or some combination of the two. A magnetic hard disk, an opticaldisk, or another form of storage for large amounts of data may also beused in some embodiments, although the form factors for such devicestypically preclude installation as a permanent component in somedevices. Rather, a mass storage device on another computer is typicallyused in conjunction with the more limited storage of some devices. Someof this data is often written, by a direct memory access process, intomemory 130 during execution of software in the computer 105. One ofskill in the art will immediately recognize that the terms“machine-readable medium” or “computer-readable medium” includes anytype of storage device that is accessible by the processor 120 and alsoencompasses a carrier wave that encodes data information. Objects,methods, inline caches, cache states and other object-orientedcomponents may be stored in the non-volatile storage 140, or writteninto memory 130 during execution of, for example, an object-orientedsoftware program.

The computer system 100 is one example of many possible differentarchitectures. For example, personal computers based on an Intelmicroprocessor often have multiple buses, one of which can be an I/O busfor the peripherals and one that directly connects the processor 120 andthe memory 130 (often referred to as a memory bus). The buses areconnected together through bridge components that perform any necessarytranslation due to differing bus protocols.

In addition, the computer system 100 can be controlled by operatingsystem software which includes a file management system, such as a diskoperating system, which is part of the operating system software. Oneexample of an operating system software with its associated filemanagement system software is the family of operating systems known asWindows CE® and Windows® from Microsoft Corporation of Redmond,Washington, and their associated file management systems. Anotherexample of an operating system software with its associated filemanagement system software is the MAC OS software, such as MAC OS X.Another example of operating system software with its associated filemanagement system software is the LINUX operating system and itsassociated file management system. Another example of an operatingsystem software with its associated file management system software isthe PALM operating system and its associated file management system.Another example of an operating system is an ANDROID, or perhaps an iOS,operating system. The file management system is typically stored in thenon-volatile storage 140 and causes the processor 120 to execute thevarious acts required by the operating system to input and output dataand to store data in memory, including storing files on the non-volatilestorage 140. Other operating systems may be provided by makers ofdevices, and those operating systems typically will have device-specificfeatures which are not part of similar operating systems on similardevices. Similarly, WinCE®, PALM, IOS or ANDROID operating systems, forexample, may be adapted to specific devices for specific devicecapabilities.

The computer system 100 may be integrated onto a single chip or set ofchips in some embodiments, and can be fitted into a small form factorfor use as a personal device. Thus, it is not uncommon for a processor,bus, onboard memory, and display/I-O controllers to all be integratedonto a single chip. Alternatively, functions may be split into severalchips with point-to-point interconnection, causing the bus to belogically apparent but not physically obvious from inspection of eitherthe actual device or related schematics.

FIGS. 2A and 2B illustrate processor-memory diagrams to describecomponents of the system, according to some embodiments. In FIG. 2A, thesystem 200 shown in FIG. 2 contains a processor 205 and a memory 210(that can include non-volatile memory), wherein the memory 210 includesan image database 215, a navigation engine 220, an indexing module 225,a scrolling module 230, an output module 235, an optional transformationmodule 240, and an optional data exchange module 245, which can also bea part of the output module 235. The optional data exchange module 245embodied in a non-transitory computer readable medium is operable toexchange data with external computer readable media. The database 215can be operably connected to the processor 205 and on a non-transitorycomputer readable storage medium for storing data that is viewed by auser as a plurality of sets of discrete images; the navigation engine220 operably connected to the processor 205 and on a non-transitorycomputer readable storage medium for parsing the plurality of sets ofdiscrete images into independently viewable subsets of the discreteimages; the indexing module 225 operably connected to the processor 205and on a non-transitory computer readable storage medium for point-freeindexing, including location and retrieval, of each of the independentlyviewable subsets of the discrete images for an independent selection ofeach of the independently viewable subsets of the discrete images; thescrolling module 230 operably connected to the processor 205 and on anon-transitory computer readable storage medium for assembling each ofthe independently viewable subsets of the discrete images as a dataseries of the discrete images for scrolling through the desired subsetas the data series of the discrete images; the navigation device 211operably connected to the navigation engine 220 for efficientlyselecting and viewing each of the independently viewable subsets of thediscrete images.

The system includes an input device (not shown) operable to receive dataon a non-transitory computer readable medium. Examples of input devicesinclude a data exchange module 245 operable to interact with externaldata formats, voice-recognition software, a hand-held device incommunication with the system including, but not limited to, amicrophone, and the like, as well as a camera or other video imagecapture and transmission device. It should be appreciated that thesystem can be adapted to receive an analog or digital audio or video.

The image database 215 can be operable to store image files for accesson a non-transitory computer readable storage medium. In someembodiments, the system can store original image files, copies of imagefiles, and the like. Any image file known to one of skill in the art canbe stored, including, but not limited to image files are composed ofdigital data that can be rasterized for use on a computer display orprinter. An image file format may be used to store data such as, forexample, in uncompressed, compressed, or vector formats. In someembodiments, the system can receive, store, and provide access to any ofa variety of image formats through a data exchange module, as discussedabove.

In some embodiments, the images can be in a DICOM format, such as thatused in the picture archiving and communication systems (PACS) used inmodern medical imaging technology. The universal format for PACS imagestorage and transfer is DICOM (Digital Imaging and Communications inMedicine). Non-image data, such as scanned documents, may beincorporated using consumer industry standard formats like PDF (PortableDocument Format), once encapsulated in DICOM.

Other formats include raster, HDR raster, vector, compound, and stereovideo. Examples of raster formats include, but are not limited to,JPEG/JFIF, JPEG 2000, Exif, TIFF, RAW, GIF, BMP, PNG, PPM, PGM, PBM, PNMand PFM, PAM, and WEBP. Examples of HDR raster formats include, but arenot limited to, RGBE (Radiance HDR), IFF-RGFX. Other image file formatsof the raster type include, but are not limited to, JPEG XR, TGA(TARGA), ILBM (IFF-style format for up to 32 bit in planarrepresentation, plus optional 64 bit extensions), DEEP (IFF-style formatused by TVPaint), IMG (Graphical Environment Manager image file; planar,run-length encoded), PCX (Personal Computer eXchange), ECW (EnhancedCompression Wavelet), IMG (ERDAS IMAGINE Image), SID (multiresolutionseamless image database, MrSID), CD5 (Chasys Draw Image), FITS (FlexibleImage Transport System), PGF (Progressive Graphics File), XCF(eXperimental Computing Facility format, native GIMP format), PSD (AdobePhotoShop Document), PSP (Corel Paint Shop Pro), VICAR file format(NASA/JPL image transport format). Examples of vector formats include,but are not limited to, CGM, Gerber File Format (RS-274X), SVG. Other 2Dvector formats include but are not limited to, AI (Adobe Illustrator),CDR (CorelDRAW), DrawingML, GEM metafiles (interpreted and written bythe Graphical Environment Manager VDI subsystem), Graphics LayoutEngine, HPGL, HVIF (Haiku Vector Icon Format), MathML, MetaPost, Myvvector format, NAPLPS (North American Presentation Layer ProtocolSyntax), ODG (OpenDocument Graphics), !DRAW, POV-Ray markup language,PPT (Microsoft PowerPoint), Precision Graphics Markup Language, PSTricksand PGF/TikZ, ReGIS, Remote imaging protocol, VML (Vector MarkupLanguage), WMF/EMF (Windows Metafile/Enhanced Metafile), and Xar. 3Dvector formats include, but are not limited to, AI (Adobe Illustrator),CDR (CorelDRAW), DrawingML, GEM metafiles, Graphics Layout Engine, HPGL,HVIF (Haiku Vector Icon Format), MathML, MetaPost, Myv vector format,NAPLPS (North American Presentation Layer Protocol Syntax), ODG(OpenDocument Graphics), !DRAW, POV-Ray markup language, PPT (MicrosoftPowerPoint), Precision Graphics Markup Language, PSTricks and PGF/TikZ,ReGIS, Remote imaging protocol, VML (Vector Markup Language), WMF/EMF(Windows Metafile/Enhanced Metafile), Xar format, XPS (XML PaperSpecification). Examples of compound formats include but are not limitedto, AI (Adobe Illustrator), CDR (CorelDRAW), DrawingML, GEM metafiles,Graphics Layout Engine, HPGL, HVIF (Haiku Vector Icon Format), MathML,MetaPost, Myv vector format, NAPLPS (North American Presentation LayerProtocol Syntax), ODG (OpenDocument Graphics), !DRAW, POV-Ray markuplanguage, PPT (Microsoft PowerPoint), Precision Graphics MarkupLanguage, PSTricks and PGF/TikZ, ReGIS, Remote imaging protocol, VML(Vector Markup Language), WMF/EMF (Windows Metafile/Enhanced Metafile),Xar format, XPS (XML Paper Specification). Examples of stereo formatsinclude, but are not limited to, MPO, PNS, and JPS.

One of skill will appreciate that the teachings provided herein are notlimited to particular file formats, and that any audio or video formatknown to one of skill in the art can be used in some embodiments. Forexample, the audio file can comprise a format that supports one audiocodec and, in some embodiments, the audio file comprises a format thatsupports multiple codecs. In some embodiments the audio file comprisesan uncompressed audio format such as, for example, WAV, AIFF, and AU. Insome embodiments, the audio file format comprises lossless compressionsuch as, FLAC, Monkey's Audio having file extension APE, WavPack havingfile extension WV, Shorten, Tom's lossless Audio Kompressor (TAK), TTA,ATRAC Advanced Lossless, Apple Lossless, and lossless WINDOWS MediaAudio (WMA). In some embodiments, the audio file format comprises lossycompression, such as MP3, Vorbis, Musepack, ATRAC, lossy WINDOWS MediaAudio (WMA) and AAC.

In some embodiments, the audio format is an uncompressed PCM audioformat, as a “.wav” for a WINDOWS computer readable media, or as a“.aiff” as a MAC OS computer readable media. In some embodiments aBroadcast Wave Format (BWF) can be used, allowing metadata to be storedin the file. In some embodiments, the audio format is a lossless audioformat, such as FLAC, WavPack, Monkey's Audio, ALAC/Apple Lossless. Insome embodiments, the lossless audio format provides a compression ratioof about 2:1. In some embodiments, the audio format is a free-and-openformat, such as wav, ogg, mpc, flac, aiff, raw, au, or mid, for example.In some embodiments, the audio format is an open file format, such asgsm, dct, vox, aac, mp4/m4a, or mmf. In some embodiments the audioformat is a proprietary format, such as mp3, wma, atrac, ra, ram, dss,msv, dvg, IVS, m4p, iklax, mxp4, and the like.

In addition, the system can include an output module 235 embodied in anon-transitory computer readable medium, wherein the output module 235is operable to transmit data to an output device, which can be agraphical user interface, or video display, which can optionally besupported by one or more other output devices by the output module 235.The output device can be operable to provide audio data to the user,wherein the audio data can be used to assist the user in viewing imagedata.

In some embodiments, the input device comprises a microphone and/orcamera and, in some embodiments, the output module 235 transmits animage, sets of images, or a video stream to a graphical user interface.In some embodiments, the output device comprises a speaker, a graphicaluser interface, or both a speaker and a graphical user interface, forexample.

One of skill will appreciate that time stamping of data samples can alsobe used to assemble data streams. In some embodiments, an audio datastream can be used with a graphical display. And, the audio data canhave a variety of formats known to one of skill.

In addition to accessing images quickly and efficiently for ease ofreview, the system can also be adapted to include the ability to modifyimages, enhance images, combine images, average images, subtract oneimage from another, change image format, and the like. As such, thesystems can further comprise the transformation module 240 operablyconnected to the processor and on a non-transitory computer readablestorage medium for transforming the image data into a modified set ofimages by the user. Likewise, the user can have the ability to selectimages from within a data-stack using, for example, subjective userselection, one or more software image filtering algorithms or otherknown methodologies, default image criteria, and the like. As such, thesystem can further parse the images into a preferred subset of images bythe user. Although this functionality can be provided by any of theengines or modules taught herein, or can be built into a dedicatedparsing module, in some embodiments, the transformation module 240 isconfigured to provide this parsing function. Likewise, the system caninclude a parsing function that includes image enhancement. As such, thetransformation module 240 can be configured to alter the preferredsubset of images through image enhancement as a step in the parsing.

One of skill will also appreciate the value in communicating with asecond user. For example, the second user can be a second physician orother professional that can assist in the analysis or interpretation ofan image or image data-stack. As such, the system can further comprise adata exchange module 245 for sending or receiving data with a seconduser, wherein the navigation device can include a state selector thatcontrols the sending or receiving with the second user. The dataexchange module 245 is embodied in a non-transitory computer readablemedium and is operable to exchange data with external computer readablemedia. The data exchange module can, for example, serve as a messagingmodule operable to allow users to communicate with other users havinglike subject-profiles, or others users in a profile independent manner,merely upon election of the user. The users can email one another, postblogs, or have instant messaging capability for real-timecommunications. In some embodiments, the users have video and audiocapability in the communications, wherein the system implements datastreaming methods known to those of skill in the art. In someembodiments, the system is contained in a hand-held device; operable tofunction as a particular machine or apparatus having the additionalfunction of telecommunications, word processing, or gaming; or operableto function as a particular machine or apparatus not having othersubstantial functions.

FIG. 2B shows some additional features. For example, one of skill willappreciate that the efficiency in indexing and scrolling through adata-stack can result in scrolling too fast and overlooking image data.As such, the teachings provided herein can help ensure that does notoccur. In some embodiments, the systems, components, devices, andmethods provided herein govern the speed at which images are reviewedwhile still providing rapid scrolling to the region of interest. Assuch, the teachings provided herein include systems and methods thatincorporate use of a dwell module 250 for governing the speed at which auser can scroll through images in a data-stack. Moreover, the dwellmodule 250 can be configured to further control the acceleration of thescrolling.

Moreover, one of skill will also appreciate that production of videostreams of medical data can be valuable, for example, in the diagnosesor understanding of a disease. As such, the image enhancement providedby the systems herein can include the storage, display, and or creationof a video stream using the preferred subset of images. For example, thesystems and methods taught herein can include a video engine 255 forproducing and/or displaying a video stream of images in the data-stack.

One of skill will also appreciate that an analysis of the images in thedata-stack can be facilitated through dictation, providing voicecommands, as the images are reviewed. As such, the systems and methodstaught herein can include a dictation module 260 for prompting,receiving, and/or otherwise processing the analysis by the user as inputthrough voice and/or text commands.

One of skill will also appreciate that an analysis of the images in thedata-stack can be facilitated through a systematic analysis that can beeither a default systematic analysis script, or a customized systematicanalysis script, either of which can have script “pathways” that arefollowed by the system in a manner depending on the user's priorresponse or responses. In some embodiments, the user can be prompted byeither a default, or custom, analysis script as the images are reviewed.As such, the systems and methods taught herein can include an analysismodule 265 for prompting automatically, or upon request, a scriptedanalysis format for the analysis of one or more images by the user. Thescripted analysis can be, for example, a link of series of images to achecklist of queries regarding that “type” of image set. In someembodiments, the “type” of image set can be (i) imaging technology, (ii)disease state, (iii) region of the body, or any combination thereof. Insome embodiments, the queries can be default queries, customized queriesdesigned for a particular physician, practice group, geographicalpractice area, standard of care, patient, disorder, or disease state, ora combination thereof. The dictation module, for example, can link oneor more series of images in the data stack to a default checklist ofqueries selected from a group consisting of queries based on imagingtechnology, a disorder or disease state, region of the body, a standardof care, or a combination thereof. In some embodiments, the dictationmodule can link one or more series of images in the data stack to acustom checklist of queries selected from a group consisting of queriesbased on a physician's preference, a practice group's preference, aparticular patient, variations in a disorder or disease state, a set ofsymptoms, or a combination thereof.

The user control interface 270 is operably connected to the processorand can include a non-transitory computer readable medium for modifyinga user control, such as the navigation device 211,275, namely thescrolling state selector 212 and/or the indexing state selector 213. Theuser control interface 270 can modify, for example, the speed and/oracceleration of the scrolling, the linkage between the set of images,subset of images, or discrete images and particular graphical userinterface displaying the set of images, subset of images, or discreteimages that are controlled by that particular navigation device 211,275.Other I/O devices that may be controlled by the user control interfacecan include a keyboard, disk drives, printers, a scanner, and otherinput and output devices, including a mouse or other pointing device andone or more monitors (graphical user interfaces.)

The systems taught herein can be practiced with a variety of systemconfigurations, including personal computers, multiprocessor systems,microprocessor-based or programmable consumer electronics, network PCs,minicomputers, mainframe computers, and the like. The teachings providedherein can also be practiced in distributed computing environments wheretasks are performed by remote processing devices that are linked througha communications network. As such, in some embodiments, the systemfurther comprises an external computer connection through the dataexchange module 245 and a browser program module (not shown). Thebrowser program module (not shown) can be operable to access externaldata as a part of the data exchange module 245.

FIG. 3 is a concept diagram illustrating the system, according to someembodiments. The system 300 contains components that can be used in atypical embodiment. In addition to the image database 215, thenavigation engine 220, the indexing module 225, the scrolling module230, and the output module 235 shown in FIG. 2 , the memory 210 of thedevice 300 also includes a data exchange module 245 and the browserprogram module (not shown) for accessing the external data. The systemincludes a speaker 352, display 353, and a printer 354 connecteddirectly or through I/O device 350, which is connected to I/O backplane340.

In some embodiments, the system 300 can be implemented in a stand-alonedevice, rather than a computer system or network. In FIG. 3 , forexample, the I/O device 350 connects to the speaker (spkr) 352, display353, and microphone (mic) 354, but could also be coupled to otherfeatures. Such a device can have a left-hand indexing state selector341, a left-hand scrolling state selector 342, a right-hand indexingstate selector 343, a right-hand scrolling state selector 344, an “nth”indexing state selector 345, an “nth” scrolling state selector 346, anda timer state selector 347 for assisting in governing the speed of imageanalysis, with each state selector connected directly to the I/Obackplane 340.

In some embodiments, the system further comprises security measures toprotect the subject's privacy, integrity of data, or both. Such securitymeasures are those well-known in the art such as firewalls, software,and the like. In addition, the system can be configured for use in anenvironment that requires administrative procedures and control. Forexample, the system can include an administrative module (not shown)operable to control access, configure the engines, monitor results,perform quality assurance tests, and define audiences for targeting andtrending. Since the system can safely be provided by a network and, insome embodiments, the system is coupled to a network, the securitymeasures can help protect the contents of the system from externalintrusions.

In some embodiments, the system is a web enabled application and canuse, for example, any version of a Hypertext Transfer Protocol (HTTP)and Hypertext Transfer Protocol over Secure Socket Layer (HTTPS)available to one of skill, such as HTML5. These protocols provide a richexperience for the end user by utilizing web 2.0 technologies, such asAJAX, Macromedia Flash, etc. In some embodiments, the system iscompatible with Internet Browsers, such as Internet Explorer, MozillaFirefox, Opera, Safari, etc. In some embodiments, the system iscompatible with mobile devices having full HTTP/HTTPS support, such asiPhone, PocketPCs, Microsoft Surface, Video Gaming Consoles, and thelike. In some embodiments, the system can be accessed using a WirelessApplication Protocol (WAP). This protocol will serve the non HTTPenabled mobile devices, such as Cell Phones, BlackBerries, Droids, etc.,and provides a simple interface. Due to protocol limitations, the Flashanimations are disabled and replaced with Text/Graphic menus. In someembodiments, the system can be accessed using a Simple Object AccessProtocol (SOAP) and Extensible Markup Language (XML). By exposing thedata via SOAP and XML, the system provides flexibility for third partyand customized applications to query and interact with the system's coredatabases. For example, custom applications could be developed to runnatively on iPhones, Java or .Net-enabled platforms, etc. One of skillwill appreciate that the system is not limited to any of the platformsdiscussed above and will be amenable to new platforms as they develop.

FIG. 4 illustrates a method for a rapid, efficient viewing of adata-stack through a graphical user interface, according to someembodiments. Generally speaking, the method can comprise storing 405 adata-stack on a database that is operably connected to a processor, thedatabase on a non-transitory computer readable storage medium forstoring the data that is viewed by a user as a plurality of sets ofdiscrete images; parsing 410 the plurality of sets of discrete imagesinto independently viewable subsets of the discrete images with anavigation engine operably connected to the processor and on anon-transitory computer readable storage medium; indexing 415 each ofthe independently viewable subsets of the discrete images for anindependent selection of each of the independently viewable subsets ofthe discrete images with an indexing module operably connected to theprocessor and on a non-transitory computer readable storage medium toenable point-free indexing of the subsets of the discrete images;assembling 420 each of the independently viewable subsets of thediscrete images as a data series of the discrete images for scrollingthrough the data series with a scrolling module operably connected tothe processor and on a non-transitory computer readable storage medium;and, point-free selecting 425 of each of the independently viewablesubsets of the discrete images with a navigation device operablyconnected to the navigation engine. The point-free selecting caninclude, for example, independently selecting and scrolling 430, (i)selecting a desired subset within the independently viewable subsetswith an indexing state selector, the desired subset indexed for anefficient selection with a point-free, activation of the state selectorand, (ii) scrolling through the desired subset as a data series of thediscrete images with a scrolling state selector. The viewing 435 of theimages in the data-stack can be accomplished using a graphical userinterface operably connected to the processor, following which, thecompleting of the viewing allows the user to provide an analysis of theimages in the data-stack.

FIG. 5 illustrates a prior art navigation device used in viewing adata-stack of images, the device being a mouse with a selection buttonand a scroll wheel. In view of the prior art device, one of skill willappreciate the increased efficiency provided by the systems, components,devices, and methods taught herein. For example, in some embodiments,the teachings presented herein result in completing the viewing of thedata-stack in a total viewing time that is at least 5%, at least 10%, atleast 15%, at least 20%, at least 30%, at least 40%, at least 50%, orany range therein in increments of 1%, faster than a second method usinga mouse with a selection button and a scroll wheel to (i)point-and-click to select each of the independently viewable subsets onthe graphical user interface, (ii) scroll through the desired subset,and (iii) point-and-click to select, both methods having an accuracythat is the same, or at least substantially the same. In someembodiments, the efficiency in the time of the viewing is improved overthe second method by an amount ranging from 5% to 50%, 5% to 40%, 5% to30%, 5% to 20%, 5% to 15%, 6% to 40%, 7% to 35%, 8% to 30%, 9% to 25%,10% to 20%, 7% to 18%, 8% to 16%, 9% to 15%, or any range therein inincrements of 1%. In some embodiments, the efficiency in the total timeof the viewing is improved over the second method by an amount greaterthan 5%, 10%, or 15%, but also less than 50%, 48%, 46%, 44%, 42%, 40%,38%, 36%, 34%, 32%, 30%, 28%, 26%, 24%, 22%, 20%, 18%, or 16%, or anyamount or range therein, in increments of 1%, in such embodiments.

For purposes of teachings provided herein, the term “at leastsubstantially” can be used to refer to a value that does not provide asignificantly different solution than the reference value. In someembodiments, one value is at least substantially the same as a referencevalue where the value does not exceed one standard deviation from thereference value.

The teachings provided herein use the medical field as a forum fordiscussing the benefits of the systems and methods presented. It shouldbe appreciated that an image data-stack of any type can be viewed usingthe teachings provided herein. In some embodiments, the medical imagedata includes radiographs or CT images. In some embodiments, the medicalimage data includes magnetic resonance imaging. In some embodiments, themedical image data includes sonographs. And, in some embodiments, themedical image data includes PET images. As such, the teachings include asystem for a rapid, efficient viewing of a data-stack of medical imagesthrough a graphical user interface. Such systems can comprise aprocessor; a database operably connected to the processor and on anon-transitory computer readable storage medium for storing medicalimage data that is viewed by a user as a plurality of sets of discreteimages; a navigation engine operably connected to the processor and on anon-transitory computer readable storage medium for parsing theplurality of sets of discrete images into independently viewable subsetsof the discrete images; an indexing module operably connected to theprocessor and on a non-transitory computer readable storage medium forindexing each of the independently viewable subsets of the discreteimages for an independent selection of each of the independentlyviewable subsets of the discrete images; a scrolling module operablyconnected to the processor and on a non-transitory computer readablestorage medium for assembling each of the independently viewable subsetsof the discrete images as a data series of the discrete images forscrolling through the desired subset as the data series of the discreteimages; and, a navigation device operably connected to the navigationengine for efficiently selecting and viewing each of the independentlyviewable subsets of the discrete images.

As described herein, the universal format includes PACS image storageand transfer using DICOM (Digital Imaging and Communications inMedicine). In some embodiments, the PACS includes a web-based interfaceto utilize the internet or a Wide Area Network, for example, a VPN(Virtual Private Network) or SSL (Secure Sockets Layer). In someembodiments, the client side software may use ACTIVEX, JAVASCRIPT and/ora JAVA APPLET. In some embodiments, a more robust PACS system can beused that is operably connected to the full resources of the computerthe PACS system is executing on, which may also accommodate frequent WebBrowser and Java updates. In some embodiments, the PACS system willsupport DICOM part 18 of the DICOM standard. In some embodiments, WebAccess to DICOM Objects (WADO) is used, creating the necessary standardto expose images and reports over the web as a portable medium. As such,the PACS architecture can have cross-platform operability, in which WADOcan increase the distribution of images and reports to referringphysicians and patients. And, in some embodiments, the system includesan image backup for HIPAA compliance. In these embodiments, the systemautomatically sends copies of the images in the image database to aseparate computer for offsite storage.

The teachings provided herein can be used to improve current,state-of-the-art image analysis procedures and systems, such as the PACSsystems. As such, the systems, components, devices, and methods in suchstate-of-the-art technology is hereby incorporated herein by referencein their entirety. See, for example, Strickland, N. H. Arch Dis Child83:82-86 (2000); and, Alamu, F. O. International Journal of ComputerApplications 34(4):12 (2011). It should be appreciated that current,state of the art procedures can search and extract images through adedicated PACS server, for example, using DICOM messages and imageattributes through a “C-FIND” query and a “C-MOVE” or “C-GET” request.The query can include, for example, a patient ID, as well as an ID forthe user of the PACS system. The server responds with a list of C-FINDresponses, each of which also represents a list of DICOM attributes,populated with values for each match. The user extracts the attributesof interest from the response to select images. The images can then beretrieved from the PACS server through either the C-MOVE or the C-GETrequest at the study, series or image level (set, subset, or discreteimage). C-MOVE is most commonly used within enterprises and facilities,whereas C-GET is more practical between enterprises. This is because theC-MOVE request specifies “where” the retrieved images should be sentusing an identifier known for the destination, the server mapping thedestination to a TCP/IP address and port, knowing in advance all of thedestinations. As such, the C-MOVE uses separate destinations on one ormore separate connections. A C-GET, on the other hand, use the sameconnection as the request, not requiring that the “server” know thedestinations of the TCP/IP address and port in advance, more easilyworking through firewalls and network address translations, which areenvironments in which C-MOVE messages may not get through. In someembodiments, other retrieval mechanisms, including WADO, WADO-WS andmost recently WADO-RS, can be used in addition to the traditional DICOMnetwork services, particularly for cross-enterprise use. The systems,components, devices, and methods taught herein at least speed up thenavigation of images through the state-of-the-art systems, efficientlyhandling image selection and review, as well as reducing repetitivemovements that are the result of the standard point-and-click navigationdevices.

To facilitate an independent selection and mapping of discrete imagesfor a highly efficient viewing and retrieval, the method can includegiving each image it's own identification means to provide a “linkingmechanism” between the navigation device and the sets, subsets, anddiscrete images to allow for the rapid, efficient indexing between theuser and images. In some embodiments, the means for identifying adiscrete image, or set of images, can include any parameter that can beused to assist in parsing or otherwise filter the images. In someembodiments, the parsing or filtering can be accomplished using any of avariety of criteria, such as image type, such as imaging technology;body part or object imaged, including position of the image within thebody part or object, time imaged, and the like; and, the subject imaged,perhaps including details regarding the subject imaged such as name,age, sex, ethnicity, disease, genomic markers, other correlatingdiagnostics, and the like. As such, the indexing step can includefurther indexing/identifying each of the discrete images for independentselection of each of the discrete images as a single image or acustom-designed set of images. In some embodiments, the images areprovided with a systematic, or random, alphanumeric identifier, barcode, or other known means of identification. For example, theidentifiers can provide an indexing mechanism, or linking mechanism,which allows the user to identify a data-stack, a set within adata-stack, a subset within the data-stack, or a discrete image withinthe data-stack.

FIGS. 6A-6D illustrate a “point-and-click-free” process of viewingimages in a data-stack from the perspective of a user of the systemstaught herein, according to some embodiments. FIG. 6A shows a graphicaluser interface 605 having a set 610 of images selected by the user withthe indexing state selector without requiring a point-and-click motionof a mouse. FIG. 6B shows a graphical user interface 605 having a subset615 of set 610 of images selected by the user with the indexing stateselector without requiring a point-and-click motion of a mouse. FIG. 6Cshows a graphical user interface 605 having select discrete images 620from within subset 615 of set 610 of images, each selected by the userusing the scrolling state selector to view the images selected withoutrequiring a point-and-click motion of a mouse. FIG. 6D shows a graphicaluser interface 605 having a select, discrete image chosen by the viewerwhich represents the best of select, discrete images 620 from FIG. 6C.The desired image 625 can be a single image from within the select,discrete images 620, or it can be the result of the user enhancing ormodifying the image to assist in the diagnosis or display of a disorder630 present in the select, discrete images 620. In some embodiments, thedesired image can be an average of one or more of the select, discreteimages 620. In some embodiments, the desired image can be a digitalenhancement of one of the select, discrete images 620, such as acontrast enhancement, brightness enhancement, noise reduction, thedifference of an image subtraction from another image in the data-stack,and the like.

In some embodiments, the identifier or identifiers provide a sufficientnumber of permutations or variability among each image such that eachimage will have a unique identifier among all images. In someembodiments, each image is unique to all images in the image databasefor 1 month, 6 months, 1 year, 2 years, 5 years, 10 years, 20 years, 50years, 100 years, or for all time. In some embodiments, the image database can be a master image storage database accessible throughdownstream computing systems over a computer network such as an intranetor internet. As such, the indexing state selector can be adapted toprovide a rapid, efficient one-click indexing to sets, subsets, anddiscrete images, along with a scrolling state selector for scrollingthrough the sets and subsets to the discrete images, resulting in lessrepetitive motions by the user.

FIG. 7 provides a flowchart illustrating the slower, more complex priorart point-and-click method of viewing a data-stack of images, accordingto some embodiments. The method can comprise storing 705 a data-stack ona database that is operably connected to a processor, the database on anon-transitory computer readable storage medium for storing the datathat is viewed by a user as a plurality of sets of discrete images;parsing 710 the plurality of sets of discrete images into independentlyviewable subsets; assembling 720 each of the independently viewablesubsets of the discrete images as a data series having, for example,sagittal and axial views; selecting 725 each of the independentlyviewable subsets of sagittal and axial discrete images with apoint-and-click mouse on the graphical user interface; moving 726 themouse to select a sagittal series of images, pointing to an imagerepresenting the series, and clicking to select the series; scrolling727 through the sagittal series of images, moving the mouse to selectdiscrete sagittal images, pointing to the images, and clicking to selectthe discrete sagittal images; moving 728 the mouse to select an axialseries of images, pointing to an image representing the series, andclicking to select the series; scrolling 729 through the axial series ofimages, moving the mouse to select discrete axial images, pointing tothe images, and clicking to select; reviewing 730 the select discretesagittal and axial images to accurately assess a first of “n” levels inthe data-stack; and repeating 740 the moving, pointing, and clicking;and, the scrolling, pointing, and clicking for the remainder of the “n”levels in the data-stack.

As can be seen from FIG. 7 , as emphasized through the underlinedportions, the current, state-of-the-art clearly requires severalrepetitious point-and-click motions using the mouse on the graphicaluser interface, motions that are eliminated using the systems,components, devices, and methods taught herein. One of skill willappreciate that the use of repetitive point-and-click motions arelaborious, and that the teachings set-forth herein provide improvedefficiencies through at least the direct selection of sets, subsets, anddiscrete images, resulting in lower repetitions of movements and,namely, the minimization, or in some embodiments elimination, of theneed to point-and-click on the graphical user interface.

To again clarify and contrast the state-of-the-art with the teachingsprovided herein, in a state-of-the-art PACS image display used incurrent image navigation, the images are grouped into “stacks” ofrelated images which are considered series. The stack of images may berelated by imaging plane (for example, axial, sagittal, or coronal),reconstruction algorithm (bone, soft tissue, brain, etc.) or otherspecified criteria. The stack of images contained in a series areselected by point-and-click and then further navigated in a linearfashion by scrolling up and down using the mouse “wheel”. The use of thecombination of point-and-click with the mouse wheel is done with theuser's dominant upper extremity and creates the need for an excessiveamount of repetitive motions, costing excess time in the navigation andcausing repetitive stress injuries in the user. As set-forth herein, thesystems, components, devices, and methods provided significantly reducethe time-related costs and occupational injuries caused by thesenavigational limitations by creating a direct-selection mechanism thateliminates the need for point-and-click efforts. Although, the use ofpoint-and-click can be made available to accompany the navigation devicein some embodiments, it can be entirely eliminated. In some embodiments,the navigation device includes a scrolling platter and a series ofone-click buttons corresponding to particular locations in a data-stack.In some embodiments, the navigation device includes a plurality ofscrolling platters, each corresponding to particular set or subset ofdiscrete images, and a plurality of series of one-click buttons, eachcorresponding to particular locations in the data-stack. As such, insome embodiments, the navigation device includes a first scrollingplatter and a first series of one-click buttons that correspond to afirst graphical user interface; and, a second scrolling platter and asecond series of one-click buttons that correspond to a first graphicaluser interface. One of skill will appreciate that the systems taughtherein can have several ergonomic and time-saving configurations.

FIG. 8 illustrates a system including a bilateral, direct-selectionnavigation device, according to some embodiments. In the bilateralsystem 800, there are two diagnostic monitors 805, each monitor 805 inoperable communication with a navigation device 850 having a scrollinput 855 (scrolling state selector) that is a rotating platter; and, alinking mechanism 860 (indexing state selector) that is parsed into aplurality of one-click buttons that link directly to equally parsedgroups of image stacks or “series”. The scrolling state selector 855 andindexing state selector 860 on the left side (1) can be controlled bythe user's left hand, and the scrolling state selector 855 and indexingstate selector 860 on the right side (2) can be controlled by the user'sright hand. Each monitor 805 display stacks of images grouped intoseries (Se 1, Se 2, Se 3, Se 4 on the left monitor 805; and, Se 5, Se 6,Se 7, Se 8 on the right monitor 805).

FIG. 9 illustrates the dynamics of using a system including a bilateral,direct-selection navigation device, according to some embodiments. Inthe bilateral system 900, the left monitor 905 is linked to the leftscrolling state selector 955 and left indexing state selector 970ergonomically positioned for control by the left hand; and, likewise,the right monitor 905 is linked to the right scrolling state selector955 and right indexing state selector 970 ergonomically positioned forcontrol by the right hand. The particular button location on each of therespective indexing state selectors 960 corresponds directly with theselection to, and linkage of, the desired series shown on the respectiveleft and right monitors which are in-turn navigated using the respectiveleft or right scrolling state selector 855. For example, as shown inFIG. 9 , pressing button 2 will link the left platter with series 2 (Se2), and pressing button 5 will link the right platter with series 5 (Se5), the controls remaining linked until otherwise changed by the user.

In some embodiments, the order in which series are viewed can beselected by a default software selection, or by a custom-designed userselection. For example, a default software order of review may besequential, in which the user will simply view the images in Se 1, thenSe 2, then Se 3, and so on. A custom-designed user selection may beconfigured to view in a different order, for example, an order such asSe 1, Se 3, Se 2, and the Se 4. Or, perhaps the user prefers toalternate between left screen and right screen to balance the use of theleft hand and right hand during the course of a day, for example, Se 1,Se 5, Se 2, Se 6, Se 3, Se 7, Se 4, Se 8, and so on.

In some embodiments, where a point-and-click mouse is part of thesystem, once the series is linked to a scrolling state selector, such asa platter, the user can point-and-click the mouse anywhere on eitherscreen and the left platter will remained locked-into scrolling strictlyaccording to the series currently indexed through the linking mechanismon the left side monitor, and the right platter will remainedlocked-into scrolling strictly according to the series currently indexedthrough the linking mechanism on the right side monitor. This strictlinking, regardless of mouse position, provides the mouse as a sort ofoptional “third control” that allows for an occasional selection ofsingle image without leaving a currently scrolling position or positionson the left and/or right monitors. A third monitor can be provided as a“random selection monitor” to allow for this flexibility of use with amouse as an ancillary tool in some embodiments.

FIG. 10 illustrates a system having bilateral monitors, where at leastone monitor has a plurality of scrolling state selectors and linkingstate selectors, according to some embodiments. This figure illustrateshow more than one scrolling and linking mechanism can be used on asingle monitor. As shown in FIG. 10 , the system 1000 has a bilateralmonitors 1005 and a navigation device 1050, in which the monitor 1005 onthe left (1) has a single scrolling state selector 1055 and a singleindexing state selector 1060 linked to the respective scrolling stateselector 1055. The monitor 1005 on the right (2 or 3) has a plurality(2,3) of scrolling state selectors 1055 and a plurality of indexingstate selectors 1060 respectively linked to the plurality of scrollingstate selectors. The controlling platter (2 or 3) and respective linkingmechanism for the right monitor 1005 can be selected for use on theright monitor, for example, using a selection button that can beseparate or shared with a state selector. In some embodiments, theplatter (2 or 3) can be pushed to toggle/select the platter (2 or 3) forviewing the series linked to that particular platter at any given time.

FIG. 11 illustrates a system having three monitors, each monitor havingit's own respective platter and linking mechanism, according to someembodiments. This figure illustrates how a plurality of series can belinked through a plurality of indexing state selectors in a one-to-onerelationship with a plurality of monitors and respective scrolling stateselectors. One of skill will appreciate that such a system will decreasethe complexity of the operation, simplifying the viewing procedures and,thus, inherently reducing fatigue in the user. The system 1100 has threemonitors 1105 (1, 2, and 3) with respective scrolling state selectors.In FIG. 11 , the plurality of platters and linking mechanisms arecombined into one navigation device 1150 having scrolling stateselectors 1155 and indexing state selectors 1160, although each can bean independent navigation device, allowing for ease of positioning withany respective monitor placement. One of skill may find thisconfiguration desirable, as it allows for separation of common viewseries on their own dedicated screens, such as (1) posterior-anterior,(2) lateral, and (3) oblique; (1) axial, (2) coronal, (3) sagittal; and,the like. One of skill will also appreciate how having the relatedseries open and ready for viewing with separate controls for each wouldtranslate into a substantial time savings that translates intoproduction, and a reduction in repetitive motions that translates into areduction in repetitive stress injuries.

In some embodiments, a “substantial time savings” can be used to referto a time savings of greater than 5%, greater than 10%, greater than15%, greater than 20%, greater than 30%, greater than 40%, or greaterthan 50%. In some embodiments, the time savings can range from 5% toless than 70%, from 10% to less than 60%, from 15% to less than 50%,from 20% to less than 40%, or any range therein. In some embodiments, a“reduction in repetitive motions” can be used to refer to a reduction innumber of movements of greater than 100%, greater than 200%, greaterthan 300%, greater than 400%, greater than 500%, greater than 600%,greater than 700%, greater than 800%, or greater than 900%. In someembodiments, the reduction in number of motions can range from 2× to20×, from 3× to 15×, from 4× to 10×, 5× to 8×, 3× to 30×, 7× to 30×,7.2× to 12.2×, 7.2× to 16.8×, 12.2× to 16.8×, 12.2× to 28.4×, 16.8× to28.4×, 7.2× to 28×, 4× to 40×, 5× to 50×, or any range or amount thereinin increments of 0.1×.

The use of a mouse to select a series, for example, requires (i) amovement of the arm to hold the mouse, (ii) at least one movement of thearm to place the cursor over a desired series on a monitor, often likelyrequiring several “strokes” of the mouse on a surface to place thecursor over the desired series on the monitor, (iii) a click of themouse to select the desired series, and (iv) at least one movement ofthe mouse to remove the cursor from the image for viewing. The systems,components, devices, and methods taught herein will always require amere single push of a button. This is a basic example that shows aminimal improvement in repetitive motions of at least 4×, and oftenlikely more due to the several strokes of the mouse on the surface toplace the cursor over the desired series. Likewise, the use of a mousewheel to scroll through a series also can require several strokes of thewheel, as the wheel is designed to fit into the small housing of themouse and, as such, is of a small diameter having only a portion of thecircumference of the wheel exposed for tactile contact for scrollingthrough the series. As such, the scroll wheel of the mouse requires theuser to make several repeated and short strokes over the scroll wheel toscroll a significant distance. A scrolling state selector that is a“platter”, on the other hand, does not require repetitive stroking ofthe platter to scroll the significant distance. The platter can beconfigured with a much larger circumference than the scroll wheel of themouse, providing (i) precision when desired for carefully scrolling ashort distance on the monitor, and (ii) speed when desired for scrollingover the significant distance on the monitor. The platter provides amechanism adapted to scroll carefully without the repetitive motionsassociated with “stroking” a mouse scroll wheel, due to the largerdiameter of the platter and the ability to rotate the platter aplurality of times without the need to move, and then release, and thenmove, and again release, repeatedly.

Relative repetitive motions can be compared between the mouse scrollwheel and the platter. For example, assuming that the distance moved bya user's finger around (i) the circumference of the scrolling wheel ofthe mouse and (ii) the circumference of the platter are both equal tothe distance traveled on the monitor and, likewise, the distance/time isaccepted as a desired tactile speed of the movement of the informationacross the monitor, then the relative repetition of movements requiredto travel across one set of data on a monitor can be compared betweenthe mouse wheel and the platter. For purposes of comparison, we canfirst assume the average diameter of a mouse scroll wheel ranges fromabout 0.75 inches to about 1.25 inches, and the average platter diameterranges from about 3.0 inches to about 7.0 inches. We can then use amethod similar to the use of the circumference of a surveyor's wheel tomeasure distance traveled on the ground to measure distance traveledacross a monitor by the mouse scroll wheel relative to the distancetraveled across the monitor using the platter. The following table,Table 1, on scrolling efficiency uses this method, and assumes a 1:1circumference:distance across the monitor, to compare the repetitionsrequired to travel from top to bottom of a 17 inch computer screen(measured diagonal, corner-to-corner) with an aspect ratio of 16:10(height:width), which is a distance of about 14 inches.

TABLE 1 Mouse scroll wheel Platter scrolling state selector stateselector Diameter 0.75 1.25 3.00 7.00 (inches) Circumference 2.355 3.9259.42 21.98 (inches) Tactile surface 0.77 1.30 100% 100% exposed(inches); distance per stroke (assume 33% of wheel circumference)Repetitive 18.18 10.77 1.49 0.64 rotations motions to travel strokesstrokes rotations 14 inches = 14/distance per stroke Excess 18.18/0.64 =10.77/0.64 = repetitions of 28.4x 16.8x mouse wheel over platter18.18/1.49 = 10.77/1.49 = 12.2x 7.2x

Comparing “strokes” of a mouse scroll wheel to “rotations” of a platteris not direct. Nevertheless, it is clear that the strokes of the mousescroll wheel are purely repetitive motions, whereas the rotations arenot purely repetitive. This is because there is a clear repetitivestress applied to the user when the user touches, pushes to rotate, andthen releases the mouse scroll wheel, whereas to rotate the platter,there is no push-release repetition, merely a smooth rotation. Comparing“one stroke” of the mouse wheel to “one rotation” of the platter,however, shows that the scrolling alone is more efficient with theplatter by a factor ranging from about 7.2× to about 28.4× in view ofthe estimated wheel and platter circumferences. In addition, the stresson the user's body to rotate the platter involves much less impact thanthe stress on the user's body to stroke the wheel on the mouse. Forexample, the repetitive motion of the tendons in the sheaths in thecarpal tunnel region would be expected to be much higher when repeatedstroking the scrolling wheel of the mouse when compared to merelyrotating the platter even if the repetitive motions were equal, and thiswould be expected to be significantly exacerbated through the mousescrolling wheel by a factor of 7.2× to 28.4× in view of the repetitivestress estimate above.

FIG. 12 illustrates a system having “n” monitors, each monitor havingit's own respective platter and linking mechanism, according to someembodiments. This figure illustrates how a plurality of series can belinked through a plurality of indexing state selectors in a one-to-onerelationship with a plurality of monitors and respective scrolling stateselectors. This figure also shows that linkage between each monitor andeach navigation device can be independently selected, depending on thesubjective preferences of the user, which can change from case to case.One of skill will appreciate that such a system will decrease thecomplexity of the operation, simplifying the viewing procedures and,thus, inherently reducing fatigue in the user. The system 1200 has “n”monitors 1205 (1, 2, . . . n) with respective scrolling state selectors.In FIG. 12 , the plurality of platters and linking mechanisms arecombined into one navigation device 1250 having scrolling stateselectors 1255 and indexing state selectors 1260, although each can bean independent navigation device, or any subgroup number of devices asconvenient by design, allowing for ease of positioning with anyrespective monitor placement. One of skill may find this configurationdesirable, as it allows for separation of an of several common viewseries, or perhaps uncommon view series, on their own dedicated screens,such as any combination of 1, 2, . . . n series of images in adata-stack, or perhaps simultaneously viewing series on more than onebody region, such as in a study of metastasis throughout a cancerpatient, or perhaps distribution of trauma throughout a trauma patient.Or, perhaps simultaneously viewing series through more than one imagingtechnology, such as CT, MRI, ultrasound, etc. One of skill will alsoappreciate how having the related series open and ready for viewing withseparate controls for each series of images would translate into asubstantial time savings that translates into production, and areduction in repetitive motions that translates into a reduction inrepetitive stress injuries.

FIG. 13 illustrates various embodiments of the indexing state selector,according to some embodiments. The navigation device 1350 has scrollinputs, or scrolling state selectors 1355 and a linking mechanism, orindexing state selectors 1360. In this embodiment, the indexing stateselectors 1360 are buttons 1360 a linked to independent sets of images,subsets of images, or discrete images, such that the user does not haveto click to link the indexing state selector. One of skill willappreciate that other technologies can be used for the direct link toindependent sets of images, subsets of images, or discrete images. Forexample, gaze detection 1360 b can be used, such that the systems taughtherein may have gaze detection capabilities that allow the navigationdevice to detect when a user is looking at a particular monitor, as wellas the independent sets of images, subsets of images, or discrete imageson the monitor. When the device detects that the user is looking at themonitor, or independent sets of images, subsets of images, or discreteimages on the monitor, the device can identify and display the target ofthe user's gaze. The gaze technology can also initiate an automatictimer in the dwell module that triggers a timed scrolling, and thescrolling may pause when the device detects that the user has lookedaway from the monitor, or the independent sets of images, subsets ofimages, or discrete images displayed on the monitor. The device mayresume the scrolling timer when the device detects that the user isagain looking towards the device. Likewise, the buttons on the linkingmechanism can, in the alternative, simply be another type of stateselector 1360 c, such as an indexed knob, switch, or rotary selectiondevice or devices. Likewise, the system can index images based on apreset protocol 1360 d, which can be an autoselection based on desiredseries parameters that can be independently selected for each case, orcan be a default setting, such as axial images shown first, sagittalviews shown second, and coronal views shown third, etc. Or, axial imagescan be shown on the first monitor, while sagittal views shown on thesecond monitor, and coronal views shown on the third monitor, etc.Moreover, since vocal command systems have improved tremendously, theindexing mechanism won't even require the push of a button, but merely avocal command 1360 e in some embodiments.

FIG. 14 illustrates various embodiments of the scrolling state selector,according to some embodiments. The navigation device 1450 has scrollinputs, or scrolling state selectors 1455 and a linking mechanism, orindexing state selectors 1460. In this embodiment, the scrolling stateselectors 1455 are platters 1455 a linked to independent sets of images,subsets of images, or discrete images, such that the user does not haveto click to link the platter. One of skill will appreciate that othertechnologies can be used for the direct link to independent sets ofimages, subsets of images, or discrete images for scrolling. Forexample, a slider switch/fader 1455 b, or a tactile scrolling surface1455 c like a finger treadmill, can be used. Likewise, the buttons onthe linking mechanism can, in the alternative, simply be another type ofstate selector 1360 c, such as an indexed knob, switch, or rotaryselection device or devices. Likewise, the system can scroll imagesbased on a preset protocol, which can be an auto-scroll based on desiredseries parameters that can be independently selected for each case, orcan be a default setting, such as a scroll rate for axial views, ascroll rate for sagittal views, and a scroll rate for coronal views,etc. Or, a scroll rate for the first monitor, a scroll rate for thesecond monitor, and a scroll rate for the third monitor, etc. Moreover,since vocal command systems have improved tremendously, the scrollingmechanism won't even require the push of a button, but merely a vocalcommand to set the scrolling speed in some embodiments.

The systems and methods taught herein can support viewing of image datawith a handheld device. The CPU on a handheld computer system, however,can have difficulties concurrently processing the audio data filesdescribed herein. In some embodiments, a handheld computing system mayhave latency difficulties. As such, data files may require compression.For example, in some embodiments, the data files can be compressed usinga compression technique, for example, such as QUICKTIME by Apple. Otherfile compression techniques can be used. IMA4 can also be used tocompress the files in some embodiments. In some embodiments, the systemrequires at least a 600-700 MHz processor. An older APPLE system mighthave a 400 MHz processor, although more recent systems can have a 1300MHz processor, for example. The IMA4 compression method compresses theaudio data file, for example, to about 25% of file size. Examples ofvideo compression includes DIRAC, SMPTE, and HEVC formats. In someembodiments, it should be appreciated, however, that the system can usepure, uncompressed wave files. Many home PCs, however, may not needcompressed files due to the more powerful processors currently availablefor home PCs. The bandwidth of the computer system, i.e. the size of theCPU and memory will dictate whether compression is necessary. One ofskill in the art will appreciate that certain compression technologiesmay be needed in some systems for optimum performance and that thesetechnologies are readily identifiable and accessible.

FIG. 15 shows how a network may be used for the system, according tosome embodiments. Several computer systems are coupled together througha network 1505, such as the internet, along with a cellular network andrelated cellular devices. The term “internet” as used herein refers to anetwork of networks which uses certain protocols, such as the TCP/IPprotocol, and possibly other protocols such as the hypertext transferprotocol (HTTP) for hypertext markup language (HTML) documents that makeup the world wide web (web). The physical connections of the internetand the protocols and communication procedures of the internet are wellknown to those of skill in the art.

Access to the internet 1505 is typically provided by internet serviceproviders (ISP), such as the ISPs 1510 and 1515. Users on clientsystems, such as client computer systems 1530, 1550, and 1560 obtainaccess to the internet through the internet service providers, such asISPs 1510 and 1515. Access to the internet allows users of the clientcomputer systems to exchange information, receive and send e-mails, andview documents, such as documents which have been prepared in the HTMLformat. These documents are often provided by web servers, such as webserver 1520 which is considered to be “on” the internet. Often these webservers are provided by the ISPs, such as ISP 1510, although a computersystem can be set up and connected to the internet without that systemalso being an ISP.

The web server 1520 is typically at least one computer system whichoperates as a server computer system and is configured to operate withthe protocols of the worldwide web and is coupled to the internet.Optionally, the web server 1520 can be part of an ISP which providesaccess to the internet for client systems. The web server 1520 is showncoupled to the server computer system 1525 which itself is coupled toweb content 1595, which can be considered a form of a media database.While two computer systems 1520 and 1525 are shown in FIG. 15 , the webserver system 1520 and the server computer system 1525 can be onecomputer system having different software components providing the webserver functionality and the server functionality provided by the servercomputer system 1525 which will be described further below.

Cellular network interface 1543 provides an interface between a cellularnetwork and corresponding cellular devices 1544, 1546 and 1548 on oneside, and network 1505 on the other side. Thus cellular devices 1544,1546 and 1548, which may be personal devices including cellulartelephones, two-way pagers, personal digital assistants or other similardevices, may connect with network 1505 and exchange information such asemail, content, or HTTP-formatted data, for example. Cellular networkinterface 1543 is coupled to computer 1540, which communicates withnetwork 1505 through modem interface 1545. Computer 1540 may be apersonal computer, server computer or the like, and serves as a gateway.Thus, computer 1540 may be similar to client computers 1550 and 1560 orto gateway computer 1575, for example. Software or content may then beuploaded or downloaded through the connection provided by interface1543, computer 1540 and modem 1545.

Client computer systems 1530, 1550, and 1560 can each, with theappropriate web browsing software, view HTML pages provided by the webserver 1520. The ISP 1510 provides internet connectivity to the clientcomputer system 1530 through the modem interface 1535 which can beconsidered part of the client computer system 1530. The client computersystem can be a personal computer system, a network computer, a web TVsystem, or other such computer system.

Similarly, the ISP 1515 provides internet connectivity for clientsystems 1550 and 1560, although as shown in FIG. 15 , the connectionsare not the same as for more directly connected computer systems. Clientcomputer systems 1550 and 1560 are part of a LAN coupled through agateway computer 1575. While FIG. 15 shows the interfaces 1535 and 1545as generically as a “modem,” each of these interfaces can be an analogmodem, isdn modem, cable modem, satellite transmission interface (e.g.“direct PC”), or other interfaces for coupling a computer system toother computer systems.

Client computer systems 1550 and 1560 are coupled to a LAN 1570 throughnetwork interfaces 1555 and 1565, which can be ethernet network or othernetwork interfaces. The LAN 1570 is also coupled to a gateway computersystem 1575 which can provide firewall and other internet relatedservices for the local area network. This gateway computer system 1575is coupled to the ISP 1515 to provide internet connectivity to theclient computer systems 1550 and 1560. The gateway computer system 1575can be a conventional server computer system. Also, the web serversystem 1520 can be a conventional server computer system.

Alternatively, a server computer system 1580 can be directly coupled tothe LAN 1570 through a network interface 1585 to provide files 1590 andother services to the clients 1550, 1560, without the need to connect tothe internet through the gateway system 1575.

Through the use of such a network, for example, the system can alsoprovide an element of social networking, whereby users can contact otherusers. In some embodiments, the system can include a messaging moduleoperable to deliver notifications via email, SMS, and other mediums. Insome embodiments, the system is accessible through a portable, singleunit device and, in some embodiments, the input device, the graphicaluser interface, or both, is provided through a portable, single unitdevice. In some embodiments, the portable, single unit device is ahand-held device. In some embodiments, the systems and methods canoperate from the server to a user, from the user to a server, from auser to a user, from a user to a plurality of users, comparable to asystem that may be used in an MMO environment (massive, multi-userenvironment), from a user to a server to a user, from a server to a user(or plurality of users) and a teacher (or plurality of teachers), or aserver to a plurality of users and a conductor, for example. Theinteractions can be through real-time users, perhaps available forreal-time interaction in a forum that can be either a public, private,semi-private, or member-only chat room; or, not real-time, such as auser environment including text, wavefile, and/or video communications.A blog-type environment, or message room, is an example of anenvironment that is not real-time.

A real-time environment provides responses to communications within settime constraints, or “deadlines”. Real-time responses, for example, canbe provided on the order of milliseconds, and sometimes microseconds,ranging from 0.001 milliseconds to 999 milliseconds, from 0.01milliseconds to 900 milliseconds, from 0.02 milliseconds to 800milliseconds, from 0.03 milliseconds to 700 milliseconds, from 0.04milliseconds to 600 milliseconds, from 0.05 milliseconds to 500milliseconds, from 0.06 milliseconds to 400 milliseconds, from 0.07milliseconds to 300 milliseconds, from 0.08 milliseconds to 200milliseconds, from 0.09 milliseconds to 100 milliseconds, from 0.10milliseconds to 50 milliseconds, from 1.0 milliseconds to 10milliseconds, or any range therein in increments of 0.001 millisecond.In some embodiments, the system response occurs without perceivabledelay. It should be appreciated that the network can also be configuredto provide text and/or audio for real-time messaging, posting ofmessages, posting of instructional, posting of news or other items of arelated interest to the users, and the like.

It should also be appreciated that a network can include traditionalnetwork media for general communications by the users and the public.For example, television cable, optical fiber, satellite, and the like,in which such digital information can be transmitted to users. Such useof traditional media will facilitate use of the teachings providedherein with traditional media channels. In some embodiments, thesystems, components, devices, and methods can be used providenon-confidential information, such as information in whichconfidentiality has been legally waived, in the interest of sharinginformation over the network.

The following examples are illustrative of the uses of the presentteachings. It should be appreciated that the examples are for purposesof illustration and are not to be construed as otherwise limiting to theteachings.

Example 1. The Ergonomic Workstation Reduces the Time Required toAnalyze a Case

This example compares the time required to analyze a set of thoracic andabdominal cases using a traditional workstation based on apoint-and-click mouse control and an ergonomic workstation having thesystem with indexing and scrolling controls, such as an indexing stateselector and a scrolling state selector. Three (3) thoracic studies andthree (3) abdominal studies were compared. The data stacks for thethoracic studies contained images broken into 400-419 images showingaxial, coronal, sagittal, and maximum intensity projection (MIP) views.The data stacks for the abdominal studies contained 415-465 imagesbroken into 4 subsets of images showing axial, coronal, sagittal, andMIP views. The following table, Table 2, shows the results of thisexample:

TABLE 2 Traditional Ergonomic Traditional Ergonomic point-and- index-point-and- index-and- Method click and-scroll click scroll RegionAbdominal Thoracic Run 1 (minutes) 3.37 2.75 4.25 3.53 Run 2 (minutes)3.83 3.08 4.50 3.68 Run 3 (minutes) 4.25 3.58 4.08 3.48 Run 1 0.62 0.72time saved (minutes) Run 2 0.75 0.82 time saved (minutes) Run 3 0.670.60 time saved (minutes) AVG 41 43 time saved (seconds) ST DEV 3.9 6.6time saved (seconds)

As shown in this example, there are statistically significant timesavings available through the use of the ergonomic system. These timesavings translate into less repetitive motions for the radiologist andless repetitive stress injuries, not to mention translating into a moreproductive work day. In addition, the time savings may also result in abetter focus for the radiologist on the readings themselves, resultingin diagnoses that contain information of a higher quality. In someembodiments, the term “higher quality” can refer to a reduction inreading errors, where errors can be reduced by at least 50%, at least40%, at least 30%, at least 20%, at least 10%, or at least 5%, in someembodiments. In some embodiments, the term “higher quality” can refer toan increase in the identification of disorders or diseases, where theincrease in the identification can be at least 50%, at least 40%, atleast 30%, at least 20%, at least 10%, or at least 5%, in someembodiments.

Example 2. The Ergonomic Workstation can be Adapted to Govern the TimeSpent on Reviewing an Image or Set of Images

This example describes the use of a dwell module to control the speed,or dwell time, at which a radiologist reviews one or more images in adata-stack. From a quality of review perspective, it may be desirable togovern and/or monitor how fast the images are reviewed by group,subgroup, or individual image and, from the perspective of deliveringtimely services, it may be desirable to govern and/or monitor how slowthe images are reviewed by group, subgroup, or individual image.

The speed, or dwell time, can be defined as a set time that must bespent on a single image before it is possible to scroll or index awayfrom the image in a data-stack, or the time spent on a subset of imagesin the data-stack before it is possible to scroll or index away from thesubset of images. Or, the dwell time can be the total time spent viewingan entire case containing an entire set of images. As such, the dwelltime can range from 0.25 seconds to 1.0 hour, from 0.50 seconds to 45minutes, from 0.75 seconds to 40 minutes, from 1.0 second to 30 minutes,from 1.5 seconds to 20 minutes, from 2.0 seconds to 15 minutes, from 2.5seconds to 10 minutes, from 3.0 seconds to 9 minutes, from 4.0 secondsto 8 minutes, from 5.0 seconds to 7 minutes, from 6.0 seconds to 6minutes, from 7.0 seconds to 5 minutes, from 8.0 seconds to 4 minutes,from 9.0 seconds to 3 minutes, from 10.0 seconds to 2 minutes, from 15seconds to 1.5 minutes, from 30 seconds to 1.0 minute, or any range oramount therein in increments of 0.25 seconds.

In some embodiments, the dwell time for a single image can range from0.10 seconds to 1.0 minutes, from 0.20 seconds to 2.0 minutes, from 0.30seconds to 1.9 minutes, from 0.40 seconds to 1.8 minutes, from 0.50seconds to 1.7 minutes, from 0.60 seconds to 1.6 minutes, from 0.60seconds to 1.5 minutes, from 0.70 seconds to 1.4 minutes, from 0.80seconds to 1.3 minutes, from 0.90 seconds to 1.2 minutes, from 1.0seconds to 1.1 minutes, from 0.5 seconds to 5 minutes, or any range oramount therein in increments of 0.1 seconds. In some embodiments, forexample, the dwell time can be 0.10 seconds, 0.20 seconds, 0.30 seconds,0.40 seconds, 0.50 seconds, 0.60 seconds, 0.70 seconds, 0.80 seconds,0.90 seconds, 1.0 seconds, 1.1 seconds, 1.2 seconds, 1.3 seconds, 1.4seconds, 1.5 seconds, 1.6 seconds, 1.7 seconds, 1.8 seconds, 1.9seconds, 2.0 seconds, 2.1 seconds, 2.2 seconds, 2.3 seconds, 2.4seconds, 2.5 seconds, 2.6 seconds, 2.7 seconds, 2.8 seconds, 2.9seconds, 3.0 seconds, 3.1 seconds, 3.2 seconds, 3.3 seconds, 3.4seconds, 3.5 seconds, 3.6 seconds, 3.7 seconds, 3.8 seconds, 3.9seconds, 4.0 seconds, 4.1 seconds, 4.2 seconds, 4.3 seconds, 4.4seconds, 4.4 seconds, 4.5 seconds, 4.6 seconds, 4.7 seconds, 4.8seconds, 4.9 seconds, 5.0 seconds, or in range therein.

As such, the speed can be a scrolling speed. And, the dwell module canalso control the acceleration of the speed, such that the accelerationof the scrolling speed can also be controlled. In some embodiments, forexample, the response of the movement of the discrete images to thescrolling is linear where the acceleration is zero, and the response ofthe movement of the discrete images to the scrolling is linear where theacceleration is not zero.

The navigation speed can include consideration the speed images move,for example, in counts per inch (CPI) or dots per inch (DPI). The speedof the movement through the discrete images can be measured in terms ofCPI, which is commonly expressed as DPI—the number of steps reportedwhen the screen image moves one inch. If the default condition involvesmoving one screen-pixel or dot on-screen per reported step, then the CPIequates to DPI: dots of motion per inch of motion. The higher the CPI orDPI, the faster the image currently displayed image changes withscrolling, for example. The dwell module can be adapted to adjust thespeed, making the image scroll response time faster or slower than abaseline CPI. And, the dwell module can also be adapted to change thespeed dynamically, taking into account the absolute speed and themovement from the last stop-point. The acceleration refers to thesetting allowing the user to modify the image acceleration: the changein speed of the image movement over time while the scrolling stateselector movement is otherwise constant.

In some embodiments, when the user starts to scroll through images, thedwell module can be adapted to count the number of “counts” or “dots”received and will scroll the image stack by a corresponding number(typically multiplied by a rate factor, which can be less than 1 in someembodiments). The images scroll on the screen, for example, having agood precision. When the movement of the image passes the value set for“threshold”, the dwell module can start to scroll the image stack morequickly, changing the rate factor to a higher rate factor. The dwellmodule is adapted to provide user control, as the user can set the valueof the second rate factor by changing the “acceleration” setting. Insome embodiments, there are a plurality of scrolling state selectors,and the dwell module can be configured by the user to independentlyselect scrolling speeds and scrolling accelerations that arecustom-designed to a particular data-stack, particular user, or acombination thereof. In some embodiments, the speed and/or accelerationof one or more scrolling state selectors can have a default setting, adefault setting for a particular data-stack, a default setting for aparticular user, or a combination thereof.

One of skill will appreciate that there are numerous types of medicalimaging available, and these can be subcategorized, for example, byregion of the body, whether or not a contrast material was used, and thelike. In some embodiments, the dwell time can be set to correlate to aparticular image type or subset of image types, in which the region ofthe body or image type can affect the desired dwell time. For example,the dwell time and/or acceleration for viewing an X-ray extremity imageset can be selected independent of the dwell time for an X-ray abdominalimage set. Likewise, the dwell time for an X-ray abdominal image set canbe selected independent of the dwell time for an MRI abdominal imageset. A person of ordinary skill in the art will be able to select therange of speeds and/or accelerations that should facilitate viewing aparticular data-stack.

Example 3. Use of the Teachings Provided Herein to Interpret MRI Imagesof the Spine

This example compares the efficient teachings provided herein with thecurrent state-of-the-art practices in the magnetic resonance imaging(MRI) of the spine.

As currently performed, an MRI of the spine includes acquiring images intwo imaging planes, sagittal and axial. The two imaging planes providecomplementary information and must be reviewed concurrently to generatean accurate interpretation. As such, a bilateral configuration ofmonitors linked to a navigation device having a first scrolling stateselector and a first indexing state selector linked to the firstmonitor, and a second scrolling state selector and a second indexingstate selector linked to the second monitor, as described herein, wouldbe an efficient arrangement for an efficient review of the images.

Regardless of the viewing arrangement, the spine is reviewed on a levelby level basis, and most users generate a short description of eachlevel, then the next level, etc. With current state of the art PACS,this requires several repetitive point-and-click user inputs at eachlevel, the point-click-and-scroll repeated multiple times to generate anaccurate assessment of both the spinal canal and neural foramen at eachlevel. As a specific example in the cervical spine, there are 8 levelsthat need to be described in this fashion. One of skill will appreciatedthe numerous repetitive mouse inputs required to generate a dictation.

The teachings set-forth herein require much less from the user. The userneeds to (i) link to the series of axial images only once to the leftplatter, which links the scrolling state selector to the series withouta need to repetitively point-click-and-scroll; (ii) link to the seriesof sagittal images only once to the right platter, which likewise linksthe scrolling state selector to the series without a need torepetitively point-click-and-scroll; and, (iii) touch the platterssequentially to scroll the axial and sagittal image series for anefficient reading in less time, less effort, and less repetitivemotions.

Note also that the user no longer has to touch the mouse to complete thedictation after initially setting up the case. Due to the highlyrepetitive nature of the current state-of-the-art, the teachingsprovided herein greatly improve efficiency, at least doubling efficiencyin many applications.

Example 4. Use of the Teachings Provided Herein to Interpret CTAngiograms of the Aorta and Bilateral Lower Extremities

This example compares the efficient teachings provided herein with thecurrent state-of-the-art practices in interpret computerized axialtomography (CT) angiograms of the aorta and bilateral lower extremities.

CT technology has developed new applications, such as CT angiography toreplace conventional angiograms with the high resolution of the newtechnology to depict small vessels with very thin slices and a highnumber of images to interpret. For example, the number of images canrange from about 1000 to about 2000 images per study. One of skill willappreciate that the traditional mouse-based, point-and-click methods ofimage analysis takes a great deal of time, energy, and effort, not tomention numerous repetitive stresses on the radiologist. Additionally,many images are often added to the study using current techniques in MIP(Maximum Intensity Projection) and 3D reconstructed image generation.These additional images must be reviewed concurrently with the standardload of about 1000 to about 2000 source images, as the reconstructedimages give an overview of the anatomy while the source images providefine detail.

The systems, components, devices, and methods provided herein have beenused to reduce the time, energy, effort, and stresses involved ininterpreting such a complex study. For example, a single button presscan be used to link the left platter with the thin section data setseries. And, another button press can be used to link the right platterto the MIP series. This bilateral configuration allows the thin sectionseries to be navigated using the left hand, while the MIP series isnavigated with the right hand, allowing for a very rapidcross-correlation of the original and reconstructed data at anefficiency that cannot be realized using state-of-the-art procedures ofimage interpretation. To perform a similar function conventionally wouldrequire using the standard mouse point-and-click methods to alternatelyselect series to correlate, greatly slowing the interpretation time andincreasing repetitive motions.

We claim:
 1. A reading navigation system for viewing reconstructedimages in a video stream with a set of indexed images that are linked toa dictation of a review of the images, the system comprising: [00016](“linking” and “dictation module”) [00017] and [00063] (“analysisscript”), [000109], [000121] (referring to image viewing as a “reading”)a processor; a navigation engine operably connected to the processor andon a non-transitory computer readable storage medium for a parsing ofthe image data for reconstructing discrete images into independentlyviewable subsets of discrete images that are custom-designed for thevideo stream, the parsing using criteria that includes (i) body part;and, (ii) case details selected from the group consisting of age, sex,ethnicity, disease, genomic markers, and other correlating diagnostics;a transformation module on a non-transitory computer readable storagemedium and configured for the parsing of the images into a preferredsubset of images; wherein, the parsing includes altering the preferredsubset of images through image enhancement for the video stream; anindexing module on a non-transitory computer readable storage medium andconfigured for locating and retrieving a set of indexed images by thebody part and the case details for a point-and-click-free viewing of theset of indexed images as an independently viewable subset of discreteimages; a video engine on a non-transitory computer readable storagemedium for producing and/or displaying a video stream; a dictationmodule on a non-transitory computer readable storage medium for linkingthe images with the dictation of the review of the images; and, [00016],line 2 processing the images based on a criteria for the dictation;[00016], lines 3-5 [00016] (“linking” and “dictation module”), [00017]and [00063] (“analysis script” and “dictation module can link . . .images to [default or custom questions]), and, a database operablyconnected to the processor and on a non-transitory computer readablestorage medium for storing data that is viewed by a user; wherein, theindexing of each image by the body part and the case details provides alinking mechanism for the point-and-click-free viewing of the set ofindexed images.
 2. The system of claim 1, wherein the system furtherincludes an output module on a non-transitory computer readable storagemedium and operable to transmit image data to a video display, and audiodata to a speaker for the dictating wherein the data transmitted to thevideo display and speaker is assembled as time-stamped and synchronizedwith the imaging time of each image in the set of indexed images.[00055]-[00057] (assembly of audio and video data with time-stamping,and speaker)
 3. The system of claim 1, wherein the dictating follows asystematic analysis script. [00017] and [00063], line 3 (“systematicanalysis script”)
 4. The system of claim 1, wherein the dictationfollows a systematic analysis script that includes script pathways thatdepend on a prior response to the systematic analysis script. [00017]and [00063], line 4 (“systematic analysis script”)
 5. The system ofclaim 1, wherein the criteria is selected from a group consisting ofimaging technology, a disorder or disease state, region of the body, astandard of care, or a combination thereof. [00017] and [00063], lines15-17
 6. The system of claim 1, wherein the criteria is selected from agroup consisting of a physician's preference, a practice group'spreference, a particular patient, variations in a disorder or diseasestate, a set of symptoms, or a combination thereof. [00017] and [00063],lines 19-21
 7. The system of claim 1, wherein the system includes adwell module that functions to establish a set time that must be spenton a subset of discrete images before the viewer can scroll or indexaway from the video stream.
 8. The system of claim 1, wherein the systemincludes a dwell module that functions to establish a set time that mustbe spent on a single discrete reconstructed image before the viewer canscroll or index away from the video stream.
 9. The system of claim 1,wherein the system includes a dwell module that functions to establish aset time for the total time spent viewing the entire video stream.
 10. Amethod of rapid analyzing image data using the system of claim 1, themethod comprising: storing image data on a database that is operablyconnected to a processor, the database on a non-transitory computerreadable storage medium for storing the data that is viewed by the user;viewing the video stream on a first video display; viewing of the set ofindexed images on a second video display; dictating the review of theimages; and, assembling the data transmitted to the video display andthe dictating of the review of the images as time-stamped andsynchronized with the imaging time of each image in the set of indexedimages.
 11. The method of claim 10, wherein the dictating creates audiodata, and the method includes linking the display of the set of indexedimages on the video stream with the audio data from the dictating. 12.The method of claim 11, wherein the linking includes linking a timestamp from the video data stream with the audio data from the dictatingof a review each respective image and an imaging time of each image inthe set of indexed images.
 13. The method of claim 10, wherein thedictating follows a systematic analysis script.
 14. The method of claim13, wherein the dictating follows a systematic analysis script thatincludes script pathways that depend on a prior response to thesystematic analysis script.
 15. The method of claim 10, furthercomprising selecting a criteria from a group consisting of imagingtechnology a disorder or disease state, region of the body, a standardof care or a combination thereof.
 16. The method of claim 10, furthercomprising selecting a criteria from a group consisting of a physician'sreference, a practice group's reference a articular patient, variationsin a disorder or disease state, a set of symptoms, or a combinationthereof.
 17. The method of claim 10, wherein the system includes a dwellmodule, and the method further comprises establishing a set time thatmust be spent on viewing a subset of discrete reconstructed imagesbefore the viewer can scroll or index away from the video stream, theset time governed by the dwell module.
 18. The method of claim 10,wherein the system includes a dwell module, and the viewing of the videostream includes establishing a set time that must be spent on viewingthe entire video stream before the viewer can scroll or index away fromthe video stream, the set time governed by the dwell module.
 19. Themethod of claim 10, wherein the system includes a dwell module, and theviewing of the video stream includes establishing a set time that mustbe spent on viewing a single image in the set of indexed images beforethe viewer can scroll or index away from the video stream, the set timegoverned by the dwell module.
 20. The method of claim 10, wherein thesystem includes a navigation device having a first scrolling latter anda first series of one-click buttons that correspond to a first videodisplay; and, a second scrolling latter and a second series of one-clickbuttons that correspond to a second video display, the first series ofone-click buttons and second series of one-click buttons configured asindexing state selectors for a rapid, efficient one-click indexing tosets, subsets, and discrete images, the method further comprisingdictating a first review of the images in the first video display, andlinking the image data to the audio data created in the dictating of thefirst review, and, dictating a second review of the images in the secondvideo display, and linking the image data to the audio data created inthe dictating of the second review. [See at least allowed claim 11 andthe support provided for “dictating” and “linking” above]